Austere Medicine (20)

We are writing this as a guide to help future students prepare and know what to expect when attending the Joint Special Operations Medical Training Center (JSOMTC) Special Operations Combat Medic School (SOCM). We have instructors that are SOCM/SFMS qualified and wanted to pass the knowledge on.

There is a lot of discussion on whether to place a tourniquet (TQ) "high and tight" on an arm or leg, or place 2-3 inches above the wound, even if on the forearm or lower leg, sometimes called a "double bone compartment. " There is also those who say a tourniquet can be on for 1 hour, or for 8+, so which is it?

The short answer is, it depends on the wound, who you are, and where you are.

"When do we do high-and-tight? "

High-and-tight is a "catch all" for most situations and non-medical professionals. It's easy to remember and unlikely to be placed distal (away from the injury, not between injury and heart) or be placed over a joint which would make it ineffective. High and tight also accounts for blast wounds where the wound may be more extensive or deeper than it appears, and when placing over clothes during "Care Under Fire" where the wound and location of bleeding may not be easily apparent.

https://www.youtube.com/watch?v=ql7w9ho79T8&w=560&h=315
Published on Jul 19, 2013 The Abdominal Aortic Tourniquet (AAT) is the most stable device available to treat non-compressible junctional pelvic bleeding. It is FDA approved for difficult to control inguinal bleeding.
The AAT is the only junctional device that has actually saved human life!
Click here to learn more!

https://www.youtube.com/watch?v=2KHaXzwdyes&w=560&h=315 Great video from the pros over at www.TacMedSolutions.com. Hop on over to their YouTube channel and give them a like! Uploaded on Oct 23, 2007 Visit our educational blog at www.tacmedsolutions.com for more information.

Austere medical tips for stabilizing a fractured pelvis with supplies you have in your aidbag. If you don't have a pelvis sling you can fashion a hasty sling out of a TQ and SAM splint. Take a look! www.CAGmain.com

Medical Concepts: Intrisic vs. extrinsic pressure. Synopsis: In this video we show you the difference between the two concepts of pressure using a Gen 7 CAT tourniquet, and the X-Stat trauma syringe....

LiveFire CareunderFire www.CAGmain.com In this video one of our students runs the Live Fire Care under Fire drill here at CAGmain. Its a chance for them to apply both basics courses (TCCC and Intro to Pistol) under timed pressure in a controlled environment. This past week end we ran 7 students total, and only 1 passed in time. This clip runs just over the 5 minute pass mark, but he will get another chance to try in Jan. Each student must have (Mandatory): Passed Intro to pistol and safety Intro to TCCC 2 safetys per student Eye and hearing protection The Drill: -The patient is located behind simulated cover -The student medic must engage targets and move to the patient behind cover. -If the medic breaks the cover box they must shoot a penalty -Timed shots and initiated at 30 seconds then every 60 seconds after -The student MUST engage immediately when the horn blasts, even if mid treatment. In orderTo pass: -The student must hit both steel targets twice per shot sequence (20 yards) -Identify all injuries in sequnce (MARCH) -Treat all injuries -Verbalize for hypothermia blanket and reassess every 15m In this video the student medic was using: The warrior assault systems recon Mk1 (Courtesy of www.ArizonaDefense.com) http://arizonadefensesupply.com/store/#!/WARRIOR-ASSAULT-SYSTEMS-Recon-Shooters-Cut/p/56347282/category=15066506 The CAG Tier 1 IFAK:http://cagmain.com/shop-cag/#!/CAG-Trauma-Packs/c/13147503/offset=0&sort=normal Which uses combat proven products from www.NARescue.com) 1x Gen7 CATTQ: http://cagmain.com/shop-cag/#!/Combat-Application-Tourniquet-C-A-T-Tactical-Black/p/50856842/category=13227550 1x NPA 1 Hyfin chest seal twin pack: http://cagmain.com/shop-cag/#!/Hyfin-Vent-Chest-Seal-Twin-Pack/p/50869901/category=13227552 2x Compressed Gauze 2x 4" ETD dressing:http://cagmain.com/shop-cag/#!/EmergencyTrauma-Dressing-ETD-4-in/p/50856860/category=13227550 This video was made possible by: Arizona Defense Supply www.ArizonaDefenseSupply.com and North American Rescue www.NARescue.com

The Combat Application Tourniquet was initially fielded by USSOCOM in 2004 then fast followed by conventional forces in 2005. In the early years of the Global War on Terrorism (GWOT) and prior to the implementation of modern prefabricated tourniquets, the death rate from extremity exsanguination was 23.3 deaths annually. After full implementation, this number was reduced to 3.5 deaths per year, an 85% decrease in mortality. In 2005 the Combat Application Tourniquet was selected as one of the Army’s top 10 greatest inventions and is recognized as one of the foremost advancements in pre-hospital care during the GWOT with an estimated 1,850 lives saved.

Brief History (North American Rescue) The Combat Application Tourniquet was initially fielded by USSOCOM in 2004 then fast followed by conventional forces in 2005. In the early years of the Global War on Terrorism (GWOT) and prior to the implementation of modern prefabricated tourniquets, the death rate from extremity exsanguination was 23.3 deaths annually. After full implementation, this number was reduced to 3.5 deaths per year, an 85% decrease in mortality.

In 2005 the Combat Application Tourniquet was selected as one of the Army’s top 10 greatest inventions and is recognized as one of the foremost advancements in pre-hospital care during the GWOT with an estimated 1,850 lives saved. Relentless comprehensive analysis of all deaths from extremity hemorrhage has resulted in evidence-based tourniquet improvements. This approach has yielded critical device improvements to include five refinements in the design of the Combat Application Tourniquet over the last decade. These enhancements were focused on maximizing the effectiveness of the device while minimizing morbidity. Continuous interface with end-users and researchers, literature review and tourniquet applications in both real world and simulated high stress tactical environments have made it clear, that despite tremendous success, tourniquet knowledge gaps exist in the following areas (1) single verses double routing of the band (2) Importance of slack removal prior to engaging the windlass. Closing these gaps will be accomplished through device enhancements, knowledge products and focused training.

The Combat Application Tourniquet Generation 7

When we began work on the CAT GEN 7 we considered every element that defines a tourniquet designed for combat use. We challenged ourselves to find the best, most forward-looking way possible to enhance performance and maximize application success. But we didn’t do this alone. Leveraging input from after action reviews, researchers, material scientists and you, the end-user, we were able to create the most advanced CAT to date. Every component of the CAT GEN 7 is optimized performance and reliability. The CAT GEN 7 has a single routing buckle system that (1) allows for extremely fast application and effective slack removal (2) unifies training standards and eliminates confusion by having a single protocol/directions for all applications.

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Anytime we talk about austere medicine, naturally airways come up, and for a variety of reasons. Just to catch up our audience we are going to cover a few basics, so everyone is on the same sheet of music. In this article we wont cover how and when to use a particular airway, but we rather discuss the intended use to hopefully clarify what item does what.

Anytime we talk about austere medicine, naturally airways come up, and for a variety of reasons. Just to catch up our audience we are going to cover a few basics, so everyone is on the same sheet of music. In this article we wont cover how and when to use a particular airway, but we rather discuss the intended use to hopefully clarify what item does what.

Positional Airways. These are free, weigh nothing and often overlooked for sexier, more invasive techniques. A positional airway is exactly what it sounds like, position the patients airway or body in a way that keeps the tongue off the back of the throat, or prevents them from inhaling vomit. i.e. The sniffing position, or roll you patient onto their side AKA the "Frat Boy" or recovery position.

Adjunct airways. Adjunct airways are temporary airways, that we put in place just to buy us a little time until we can do something a little more definitive. Although in many cases they are all that is needed or ever get used, they fall into the adjunct category simply because better airways are available to skilled providers.

NPAs or nasal pharyngeal airways. The correct term is NPA but its ok if you call it a nasal trumpet. An NPA is designed to go thru the nasal passage and sit just behind the tongue and keep your patients airway open, essentially keep them from snoring. In order for these to work they have to be sized correctly for the patient before placement. Make sure you keep a variety of sizes handy, I see in training people who just go thru the motions of sizing them up..... These are uncomfortable for the patient but should avoid the gag reflex.

OPAs or Oral Pharyngeal airways. The correct term is OPA but if you want to call them a J-Tube that's fine as well. OPAs are large, smooth J shaped pipes are bridges that go thru the mouth and lift the tongue off the back of the throat. This will stimulate a gag reflex and they also fall out a easier than an NPA. Its for that reason NPAs tend to be the go to adjunct airway in the field. OPAs will pass more air in most cases, so EMS folks tend to prefer the OPA because it fits in a little better with other treatments they may do later as a provider. [gallery size="medium" link="none" orderby="rand" ids="2543,2542,2544"] Supraglottic Airways (Above the glottis AKA the air flap). I tend to categorize Supraglottic airways between an adjunct and a definitive airway like intubation or crics (we will explain). These airways are designed to go "Blindly" into the back of the throat and isolate the OPENING of the trachea, by either blocking off the esophagus, as in the case of the King Lt. or by chance actually landing in the trachea proper by chance as in the case of a Combitube which does both depending on where it lands.

Supraglottic airways are procedurally easier than crics and intubation, but are still not considered definitve by most because they do NOT isolate the trachea. The right Supraglottic airway works well enough for anesthesia so they have the chops to save lives, but tend to be priced out the everyday persons IFAK. I like the KING LTby North American Rescue, its as close to Infantry proof as you can get while giving you operating room level performance. [gallery ids="2545,2546,2547" orderby="rand"] Definitive Airways. The goal of most providers is to isolate the trachea, this increases the effectiveness of any treatments they provide and reduces the risk of vomit or any other nasty's getting into the airway. If you ever get to watch an ER run a "mega code", you will notice a sigh of relief once the patient is "tubed" Surgical Airways. This is the first of two definitive airways we will discuss in this article. I've placed these just above the supraglottics, but frankly they are a teachable skill to the laymen provider. I've taught many an operator how to cric, and they have performed the procedure well. The only surgical airway we are concerned about in the field is the CricoThyroidotomy, or "Cric". With out getting into specifics you go in thru a small incision at the base of the Adams apple and slide a tube INTO the trachea. the tube should have an inflatable cuff on the end, so that when you inflate the cuff, gas must pass in and out the tube alone, and fluids cant get into the lungs. This technique bypasses the gag reflex altogether and is a great option for providers dealing with a potentially ugly airway combined with a head injury or disembowelment. This procedure is generally considered safe, im a fan of teaching it to dedicated responders but ill leave that discussion to people with letters behind their name. [gallery size="medium" ids="2548,2549"] Intubation. The gold standard for airways. Using a specialized scope and a properly sized cuffed tube, the provider slides a ET (Endotracheal) Tube directly into the trachea, and when they inflate the cuff they isolate the trachea the same as the cric we mentioned before. This requires a great amount of technique and experience, even seasoned paramedics dread having to do this in the field. A lot can go wrong and we certainly wouldn't recommend this to a laymen. Its good to know about this procedure even if you cant "tube" someone yourself. Ultimately this is where you patient is going if his level of consciousness allows it. This skill is generally for paramedic level providers and above and for good reason. It is entirely possible to use a modified version of this procedure and go thru the nose, but again it requires some skill and clinical hours to learn. [gallery columns="4" ids="2550,2551,2552,2553" orderby="rand"] Certainly there are a myriad of factors that will guide your decision on what to use and when, but that's not for this article. Consider:

Pediatrics

Individual anatomy

Spinal Injuries

Head injuries

Mass casualties scenarios

In the CAG tier 1 Med Kit we have a variety of positional airways and an NPA. Keep in mind the key to good airway management is a rock solid assessment. Here at Crisis Application Group we teach MARCH (The science is in the sequence) using what ever airway exam your competent in. and make sure to slow down for at least 5 seconds when look listen and feel. Of course if you have any questions hit us up on Facebook and as always thank you. [caption id="attachment_2314" align="aligncenter" width="654"] GREEN BERET MODERATED FORUM[/caption]

This warning fully understands that many who seek self sufficiency are not made of money and may be on a fixed income. It's always nice to get a deal on something by finding it online for cheaper, but when does the expression "You get what you pay for" come into play? When does quality become priority over price? Medical Supplies should be that line in the sand.

In CATS eat RATS: Tourniquet Comparison Article we addressed the difference between tried and true and unproven medical interventions, but now we're talking Knock-Offs and copy cats from trying to save a dime by going through unreliable vendors. Some may justify buying a cheaper tourniquet on non-reputable dealers because the differences aren't obvious to the untrained eye. Would you do that on medical supplies, such as heart or cancer meds?

I've seen many post pictures of their medical gear and I've caught fakes, knockoffs and at a minimum outdated gear. For instance, China has a terrible problem with infringing upon patents and not caring about which products they make look-alike. While it can often be harmless stuff such as clothing, there is simply no cheap way to go about quality medical supplies. If there is one thing to not be frugal about, I'd recommend it to be what you have to use on the worst day(s) of your life.

I've noticed no explanation needed for people to drop hundreds and hundreds of dollars into weapon accessories, just to turn around and relentlessly search Ebay or auction sites for used or knock off medical supplies. While I'm not denying the effectiveness of firearms and self defense, I will rebut with frequency of medical emergencies. How many times in your life have you needed to use your firearm in relation to times you've needed medical intervention? Nobody is immune to this, and you can't always trust "How to spot a fake" guides. Some are nearly identical and it is a fact that even the U.S. Military has bought batches of fake CAT tourniquets that have made their way into the battlefield, where they have failed when needed most. They are frequently used by "Military Simulation" (MILSIM) / Airsoft Operators to match their Plate Carriers to what the SOF uses without the cost. Their game is not life or death, but ours is.

The Boston Bombing and Las Vegas Concert Shooting are a testament to the proof of tourniquets in civilian, especially mass casualty incidents.You may get lucky when you roll the dice, but I'll stack the odds in my favor and go into a situation with superior training and equipment. Use a reputable dealer to negate the risks associated with subpar products that you, your loved ones and your patients will need in the most common factor of emergencies: Medical Injuries and Illness.

In the medical world, every lifesaving item you select to go into your aid bag is a critical piece of gear and should be viewed as a NO FAIL item, after all lives are actually at stake. When introducing a new medical product into the market, a professional should have the research and data readily available to back up their claims for said product. The basis of this article is about standards and maybe highlight some of the gimmicks that have been floated around to make a quick buck. Medical standards are critical with tourniquets (TQ) and their effectiveness because of the competitive history between military and civilian trauma models. As a former Special Missions medic who served as a voting member of the Committee on Tactical Combat Casualty Care (CoTCCC), the subject of tourniquets is very near and dear to me. Standards are essential and this article will discuss what the standard isn't and can’t be, what the standard looks like, how standards are achieved, followed by an example of what to look for when making tough decisions with your limited budget.

Full disclosure: We sell the Combat Application Tourniquet (CAT)

What the Standard Isn't

When shopping for gear, we often look to industry leaders as they have the credibility and experience to make recommendations for the inexperienced or new. But how is that credibility achieved? It’s the proven history of having done the hard work up front and having the documentation to show for it. If the only selection criteria someone has is how cool or "operator" a guy is there's going to be mistakes, and the medical world is no different. Consumers make the obvious assumption that due diligence has been made by the professionals in question. This isn't always the case, so its important to do some homework. Pulse oximetry is nowhere near the performance standard for a TQ. There are heart patients with no Pulse ox readings in some limbs....no tourniquets!

Marketing IS NOT data. "Cool guy Johnny" used "product XYZ" is NOT data. It validates their experience but offers no quantifiable performance metric. Just because an operator designs and uses it doesn't mean it works, or will work for you. Where is the data collection, the peer reviewed studies, and the study comparisons? Simply put, “Tacticool” is not a standard. Often times, operators are only using a particular device, because this research was ALREADY conducted... When introducing a new device, just saying a Green Beret, Ranger or Navy SEAL used it isn't enough, nor should it be because the lives of our family friends and peers are on the line.

The fact is, a good medic can make bad gear work in a pinch!

But that level of anecdotal evidence shouldn't be confused with a product that will perform at the lowest common denominator.

What the Standard Looks Like

Larry Vickers of Vickers (Corrected from Viking) Tactical routinely presents, in an educational format, the quality of his content and validates what he teaches and why his product concepts work. He provides quantifiable data and demonstrations that support his methodology. Although his tactical experience is relevant, Mr. Vickers has created an virtual encyclopedia of content and data for his approach to tactical shooting and product development. He puts in the work and validates it without relying on “Tacticool” for credibility. He is “Tacticool” because he IS credible.

C.A.G. using Ultrasound with a CAT TQ

For a tourniquet, the accepted standard for performance is a Doppler study and in some cases, the ultrasound. It’s the only way we can ensure that the device has achieved total arterial occlusion, also known as stopping the blood flow. This test needs to be performed on a human thigh, due to the large amounts of tissue and pressure required to achieve end state. Basically, we need to see if a tourniquet on the upper thigh is strong enough to cut off blood flow all the way down in the foot. Arms are, generally speaking, easy to do and shouldn't be the comparative standard for use in the field. A tourniquet must work on both the legs and arms if it’s going to make it into an aid bag. There are a few other variables we also need to consider such as TQ width, ease of application and design but none of those mean anything if at the end of the day the TQ doesn't stop a major femoral bleed.

There is no question that a skilled provider can create an improvised TQ that meets all of these criteria and will perform when the moment of truth has arrived, but the conventional homemade TQ doesn't offer the market a PREDICTABLE standard in which to train, compare, plan and gather data. Manufactured TQs provide standardization and the ability to teach down to the lowest common denominator so that critical life savings skills can be decentralized into the hands of untrained providers.

Dr. Zeitlow reviewed the prehospital use of tourniquets (CAT Tourniquets used on 73 patients with 98% success) and Combat Gauze (used on 52 patients with a 95% success rate) in the Trauma Service at the Mayo Clinic. He added that "improvised tourniquets were uniformly unsuccessful." Dr. Zeitlow also noted that the Mayo protocol calls for Combat Gauze to be used only after failure of standard gauze. There are 2 CAT tourniquets and 2 Combat Gauzes on each prehospital vehicle or aircraft.-CoTCCC minutes 2014-

When building up to human studies you often see a lot of testing done with non-human models, for example live tissue and even mannequin or cadaver tests. Again, still not the gold standard even though it seems they are validating the product. This is important to understand because there has been a release of various test data comparing the Rapid Application Tourniquet System (RATs) TQ against the CAT TQ on a mannequin. While the findings are indeed in favor of the RATs, this data in no way undermines the value and performance of the CAT nor does it provide gold standard test results for the performance of the RATs.

The CoTCCCs Role in Todays Accepted Standards

It needs to be said that few groups of people have done more to save the lives of American Service members than the CoTCCC. They have a well-documented, battle proven track record of medical excellence. The CoTCCC are directly responsible for the current level of professional respect the military and special operations currently enjoys in the medical community nationwide, better yet, GLOBALLY. In the last few days I've read a lot of attacks on the CoTCCC in favor of fads, and it reflects poorly on the veteran community as a whole.

Most active duty service members aren't aware of the CoTCCC because they have only been exposed to the intellectual product that they have been provided, loosely called TCCC. For active duty service members TCCC and CoTCCC are indistinguishable because it’s only in the civilian market where there is a new difference in the meaning. I’m not going to get into who did what and for what trademark, just know that if you have to play "six degrees of separation" to substantiate your TCCC claim, it’s misleading. My personal synopsis of the labeling issue is that the product was marketed and released before it was fully tested. In most cases that's ok because sales feedback is critical, but not in the medical world. A medical device will be in court and on trial the first time it fails. This has a huge potential to damage the credibility of the military medical model. It’s not a popularity contest, it is life and death so standards must be achieved and then maintained.

The RATs TQ displays the big red label associated with TCCC. This is misleading but I don't entirely put the blame on the RATs team, rather the company that markets the label. I know what it takes to get a medical device up and running and, thanks to regulation, it’s nearly impossible. The temptation to cut corners is too great to put the blame entirely on the makers of the RATs. Competing in a market dominated by the FDA is a challenge to all medicine and not just veteran owned companies.

Whether it works or not is irrelevant to the fact that professional credibility has been entirely undermined by this marketing tactic. Moving forward, how are we to accept the validity of any research done in support of the RATs? A veteran owned business is not removed from the challenges of competing in a free market, and that means creating content and products that withstand scrutiny and criticism, beyond the standards of a civilian company. The established civilian market doesn't want to compete with us, they want us to falter. We have the experience to back up our ideas so veterans don't have to dabble in conjecture. There is an entire community of civilians looking to undercut the military medical model, especially in trauma, and its gimmicks like this that will feed their machine. Credibility is king. I want to be clear, I'm not shooting down the efficacy of the RATs TQ, but I see nothing that demonstrates proven performance. At first glance it appears to be a glorified rehash of the old surgical tubing and it looks like a lot of other designs that have come and gone in the last few years. I’d like to see the testing, I'd like to see results. If it turns out to be the next big thing then great, good for them. At the end of the day I wish them luck, but it looks like the cart is ahead of the horse. What Should You Be Looking For? That depends on what kind of market you're in. The war has been going on for 15 years, so it’s not that there isn't room for innovation but there isn't any need to take chances either. The data is out there to substantiate the extra dollars on a limited personal budget. The question is how bad do you want to save $15? As I've mentioned from the onset of this article, we sell the CAT tourniquet and for good reason. I have personally used them so I'm happy to endorse them, but the CAT has a long standing, well documented history of saving lives. As recently as last year, the Mayo clinic is reporting upwards of a 98% success rate for properly applied CAT TQs in a pre hospital setting. Ill accept that standard for my family.

It is one of the industry dominating products because the data is out there to validate the few extra dollars it costs to buy one. Take a look and see, then ask yourself, does your tourniquet have any real results behind it? The CAT does and we've provided it below.

Conclusion

Medicine is an established industry with proven practices and standards that have been set for years because they have the proof that this approach works. Few markets have the same level of scrutiny as the medical and medical malpractice industry. Even Special Operations follows and acknowledges this fact, and it’s this approach to research and development that has established the SOF community as a credible research and development institution. We have to be careful as a community not to overlook quality standards in favor of the cool factor. Our company, Crisis Application Group Inc. (CAG) won’t be testing the RATS TQ. At the end of the day it’s the responsibility of the manufacturer to prove the validity of their product, not the job of competitors to disprove it. Our initial impression of the RATs TQ is so what, show me the data. We won’t be going down the "rabbit hole" of will it work or why it works, or doesn't. That's not to say it won't, it’s just that we aren't buying into the “Tacticool” marketing. Maybe one day the RATs will be ready for the big leagues, but so far it’s not and there's a lot of work ahead of them. CAG will stick to proven methodology, technology, and personal experiences.

"Medical and trauma emergencies are the most likely crisis that you and your family will face in any emergency. If we look at the all the recent catastrophes faced by our great nation one thing stands out as the most experienced event; TRAUMA. It doesn't matter if it’s a chainsaw accident, tornado or a gunshot wound. Life happens and you need to have the right gear. "

A firearm is the first object that comes to mind when an EDC or "Every Day Carry" list is mentioned. While I've seen card sized items and flashlights commonly added to most EDC's since then, there's a vital piece missing. We can agree that our EDC, especially our firearm, is to get through an emergency and protect ourselves and others... But what if that does not go as planned?

The Boston Bombing: A testament of the effectiveness of tourniquets outside of the battlefield, as well.

In a situation where firearms or other weapons involved, the optimal end result is that the threat is taken down, good guy escapes unharmed. Unfortunately, you and I both know that with the nature of ballistics and a high adrenaline moment of stress, that this may not be the case. Even if you have to remove your weapon from the holster, you or your loved one may be harmed in the process eliminating the threat, or you may even have shot a bystander in the process. Unless a paramedic is thirty feet away, that person may very well bleed out long before medical attention arrives. That's where your EDC Tourniquet comes along.

Extremity (Arm or Leg) bleeding is the number one preventable cause of death in Trauma Situations, which means this situation is not to be taken lightly. A tourniquet applied properly may save a life in this instance. It's better to use one, than hesitate and risk exsanguination or "bleeding out." The days of "Don't put it on or you'll lose that limb" are over, studies show that it will take 4-6 hours before permanent damage even begins. Whether 911 is coming in 15 minutes or you are in an austere situation where help may be delayed or you may have to self-transport, none of that matters if they don't make it through these next few minutes. The decision is clear: Acting now or bleed out on the spot. That's why I recommend a tourniquet being added to your EDC. Even if you don't carry a firearm daily, Medical injuries are far more likely in an emergency or austere environment than having to draw a firearm. That is why we're going to go over how to use a tourniquet and how to store them. We've already established types of tourniquets so you may make an educated purchase in another guide:Crisis Application Group: C.A.T's eat R.A.T's: Tourniquet Comparisons (CLICK HERE)

Self Aid is a critical skill

If you can visualize a hole leaking water from a watering hose as the arterial bleeding and the faucet the hose is attached to as the victim's heart, you can know "Why" you're doing it: the application of the tourniquet is basically you going farther up the hose (artery) to stop water (blood) from coming out. You may waste precious seconds with bandages and direct pressure hoping that fixes the wound. While those methods may be used to slow bleeding, you are going for arterial occlusion meaning the bright red bleeding stops. "Twist, Twist, Twist the Windlass till the bright red bleeding stops." "Where do I put this thing?" The CAT and SOFT-T only seem bulky but with a little folding you can make it's silhouette smaller. Personally, I carry at CAT tourniquet on me everywhere I go, and have at least 2 more in the car at all times. That's not even mentioning my medical supplies.

I recommend putting it on your belt, however this is not gospel and your imagination is the limit; You can use pockets, ankle holsters or truly conceal it under a shirt by looping it like a bandolier. With the belt method, you can loop the tourniquet through the belt as shown, using the velcro to your advantage.

If you're worried about a tourniquet attracting attention on a belt, you can pull a shirt or jacket over it, just as with a pistol but with less chance and worry of imprinting. If you can't get it stable enough, try using thick rubber bands to tie it into the belt. If you still can't get it working or need a more durable container for extended wear and abuse, there are a variety of tourniquet holders that are commercially available that are smooth and keep it in good condition.